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. 2021 Jul;17(3):419-427.
doi: 10.3988/jcn.2021.17.3.419.

The Ruminative Thought Style with Associated Anxiety Influences the Occurrence of Medication-Overuse Headache

Marina Ljubisavljevic  1 , Aleksandra Ignjatovic  2 , Srdjan Ljubisavljevic  3
Affiliations

The Ruminative Thought Style with Associated Anxiety Influences the Occurrence of Medication-Overuse Headache

Marina Ljubisavljevic et al. J Clin Neurol. 2021 Jul.

Abstract

Background and purpose: To determine the relationships between the ruminative thought style, parameters of psychological distress, and the occurrence of medication-overuse headache (MOH).

Methods: The study included 164 subjects: 83 patients (11 males and 72 females) who were first diagnosed as MOH, and 81 healthy subjects (22 males and 59 females) as a control group (CG). The study participants were aged 40.2±11.9 years (mean±standard deviation), and they were assessed using the Ruminative Thought Style Questionnaire and Depression Anxiety Stress Scales.

Results: The degree of rumination was higher in patients with MOH than in the CG (p<0.001). Among patients with MOH, females, patients with comorbidities, and those who overuse combined analgesic therapy had a higher degree of rumination (p=0.038, p=0.008, and p=0.015, respectively). In both the MOH patients and CG, the degree of rumination was directly correlated with depression, anxiety, and stress (r=0.473-0.557, p<0.001, for MOH; r=0.303-0.322, p<0.005, for CG). Rumination and anxiety were associated with MOH [odds ratio (OR)=1.123, 95% confidence interval (CI)=1.071-1.178, p<0.001; OR=1.091, 95% CI=1.005-1.185, p=0.039; respectively]. The analysis of the mediation model showed that the link between rumination and MOH is largely direct (86%), and to a lesser extent is additionally influenced by anxiety as a mediator (14%).

Conclusions: A ruminative thought style is associated with MOH both directly and via anxiety. Psychological strategies aimed at decreasing ruminative responses and anxiety could be useful in the prevention of MOH in selected patients.

Keywords: anxiety; medication-overuse headache; ruminative thought style.

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Conflict of interest statement

The authors have no potential conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1. Direct effect of rumination and mediating effect of anxiety in connection with medication-overuse headache (MOH) (*p<0.05, †p<0.001).
See this image and copyright information in PMC

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References

    1. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38:1–211. - PubMed
    1. D'Amico D, Grazzi L, Curone M, Leonardi M, Raggi A. Cost of medication overuse headache in Italian patients at the time-point of withdrawal: a retrospective study based on real data. Neurol Sci. 2017;38 Suppl 1:3–6. - PubMed
    1. Raggi A, Leonardi M, Sansone E, Curone M, Grazzi L, D'Amico D. The cost and the value of treatment of medication overuse headache in Italy: a longitudinal study based on patient-derived data. Eur J Neurol. 2020;27:62-e1. - PubMed
    1. Diener HC, Holle D, Solbach K, Gaul C. Medication-overuse headache: risk factors, pathophysiology and management. Nat Rev Neurol. 2016;12:575–583. - PubMed
    1. Vandenbussche N, Laterza D, Lisicki M, Lloyd J, Lupi C, Tischler H, et al. Medication-overuse headache: a widely recognized entity amidst ongoing debate. J Headache Pain. 2018;19:50. - PMC - PubMed